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€ _;t Waste Tire Sqkey & Inspection Rep�tt [SURVEY REQUIRED <br /> 'i:. <br /> 1_1 <br /> State of California <br /> CIWIVIB astew0nage Inspection Form - Page 2 <br /> California Integrated Waste Management Board <br /> Part C - Facility Information BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection <br /> Site Suffix: 1 ® ( Report I /' - /� L ! r41 �l <br /> Number: .L <br /> SWIS Inspection Number on the associated Survey form(Page 1) <br /> Number: - - Photos Taken 0 Yes 0 No <br /> Property Owner <br /> C�,p►fi t 33�-Ba$d. t`[`iV� I}t v�r`n kcc;'"Po GF1 `�saa n <br /> Exempt Business Type (Fill if applicable) l Permitted Regulatory Status (Fill one) <br /> 0 PRC§42823.5-Cement Manufacturing Plant with written verification that the facility qualifies for exemption * Permitted 0 Exempt <br /> Excluded Business Types(Fill if applicable) <br /> 0 PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) 0 Excluded 0 Unpermitted <br /> 0 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water&used for bumpers or ballast Facility Type(Fill one) <br /> 0 14 CCR§18420(a)(4)-Tire retreading facility with no more than 3,000 waste tires on premises 0 Major WTF (_>5,000 Tires) <br /> 0 14 CCR§18420(a)(6)-Auto dismantler storing no more than 1,500 waste tires for less than 90 days <br /> 14 CCR§18420 a) 7 & e -Tire dealer storing no more than 1,500 waste tires for 90 days ® Minor WTF (500-4,999 Tires) <br /> Part D - Inspection of Waste Tire Facility <br /> VI A WASTE TIRE STORAGE STANDARDS V A <br /> Permit Requirements 00 14 CCR§17352-Site Security <br /> 0 0 PRC§42824-Major Waste Tire Facility Permit 0 (a)Signs 0 (b)Site Attendant 0 (c)Access <br /> 0 0 PRC§42834-Minor Waste Tire Facility Permit 00 14 CCR§17353(a)-Vector Control <br /> PRC§42850Complies Terms of Pit 0(1)Impermeable Barrier 0 (2)Approved Vector Plan <br /> 0 (a)- ompes werm <br /> 001 14 CCR§17354-Storage of Waste Tires Outdoors <br /> 0 0 14 CCR§18420(a)-Applicable for Permit 0 (a)Storage Units <br /> 0 0 14 CCR§18423-Filing Application for Permit 0 (b)Fire Lanes <br /> 0 0 14 CCR§18432-Operations Plan 0 (c)Fire District Requirements <br /> 0 00 (d)Drainage <br /> 14 CCR§18433-Emergency Response Plan <br /> 0 (e)Slope/Grade <br /> Recordkeeping Requirement 0 (f)Siting(New Facilities) <br /> 00 14 CCR§18447-Records Available 0 (g)Rim Removal <br /> 0 0 14 CCR§17351-Fire Prevention Measures 0 (h)Protection from Pyrolytic Oil Runoff <br /> 0(a)Communication Equipment 0 (c)Water Supply 0 0 14 CCR§17356-Indoor Storage <br /> 0 (b)Fire Equipment 0 (d)Other Requirements Facility Compliance with NFPA 231 D-1989 <br /> Comments , v)/ G7Z __, 6 a 8 -/3 <br /> -to '?-,27-13 ,tiow) I`] cue l <br /> � sV t,6m L+ �y 46 SIS EL i k6 <br /> /I G�It'✓t' <br /> �-✓ +YE.3 �tSYL <br /> r&V71,je 0-✓1 �7 aVX o >f c..pc., �&�C-.) 1"n-k ic-1 <br /> rvr z)(- -�— <br /> Ire v%v -I �iI1 �' l�J�— �4 <br /> ,o. <br /> INSTRUCTIONS ON BACK Correct: Incorrect: N/ �/IFOX , p I r 15386 <br /> White Copy:CIWMB Yellow Copy.Operator Pink Copy:LEA <br />